Dibenzo azepine compounds and their use in the treatment of otic diseases and disorders

ABSTRACT

The present disclosure provides crystalline Compound I and crystalline Compound II, pharmaceutical compositions comprising one of said crystalline compounds suitable for intratympanic administration, and methods for treating otic disorders using the crystalline compounds and the pharmaceutical compositions.

BACKGROUND Field

The present disclosure is directed to the use of certain substituteddibenzo azepine derivatives and pharmaceutical compositions thereof inthe treatment of otic diseases and disorders of the inner ear. Thepresent disclosure is further directed to pharmaceutical compositionsand methods of treating otic diseases and disorders.

Description

Hearing loss afflicts over ten percent of the population of the UnitedStates. Damage to the peripheral auditory system is responsible for amajority of such hearing deficits. In particular, destruction of haircells and destruction of the primary afferent neurons in the spiralganglia, which transduce auditory signals from the hair cells to thebrain, have been implicated as major causes of hearing impairments.

Agents causing hearing impairment include loud noise, aging, infections,and ototoxic chemicals. Among the last are certain therapeutic drugs,contaminants in foods or medicines, and environmental and industrialpollutants. Therapeutic agents that have been found to have adverseeffect on hearing include aminoglycoside antibiotics (such asstreptomycin, neomycin, gentamicin, kanamycin, tobramycin and amikacin),platinum-containing antineoplastic agents such as cisplatin andcarboplatin, certain macrolide antibiotics such as erythromycin,glycopeptide antibiotics such as vancomycin, quinine and its analogs,salicylate and its analogs, and loop diuretics such as furosemide andethacrynic acid. Ototoxins such as cisplatin and aminoglycosideantibiotics accumulate in cochlear hair cells, and cellular damage tothese cells resulting from the accumulation is thought to be the primaryreason for chemically-induced hearing loss. The vestibular and auditorysystems share many characteristics including peripheral neuronalinnervations of hair cells and central projections to the brainstemnuclei. Vestibular functions are similarly sensitive to ototoxins asdescribed above.

The toxic effects of these drugs on auditory cells and spiral ganglionneurons are often the limiting factor in their therapeutic usefulness.For example, the aminoglycoside antibiotics are broad spectrumantimicrobials effective against gram-positive, gram-negative andacid-fast bacteria. They are used primarily to treat infections causedby gram-negative bacteria, often in combination with beta lactams whichprovide synergistic effects. Advantages to using the aminoglycosideantibiotics include a low incidence of Clostridium difficile diarrhearelative to other antibiotics, and a low risk of allergic reactions.However, the aminoglycosides are known to exhibit serious ototoxicity,especially at higher doses. For example, 25% of patients given one gramof streptomycin daily for 60 to 120 days displayed some vestibularimpairment, whereas at two grams per day, the incidence increased to75%, and some patients suffer permanent damage (see U.S. Pat. No.5,059,591).

Salicylates, such as aspirin, have long been used for theiranti-inflammatory, analgesic, anti-pyretic and anti-thrombotic effects.Unfortunately, salicylates have ototoxic side effects, often leading totinnitus (“ringing in the ears”) and temporary hearing loss, and if usedat high doses for a prolonged time, hearing impairment can becomepersistent and irreversible (J. A. Brien, 1993, Drug Safety 9:143-148).

Loop diuretics (such as ethacrynic acid, furosemide, and bumetanide) areknown to cause ototoxicity. Several less-commonly used loop diureticsalso have been experimentally shown to cause ototoxicity; this groupincludes torsemide, azosemide, ozolinone, indacrinone, and piretanide.Hearing loss associated with loop diuretics is frequently, but notalways, reversible.

Ototoxicity is a serious dose-limiting side-effect for cisplatin, awidely-used antineoplastic agent that has proven effective on a varietyof human cancers including testicular, ovarian, bladder, and head andneck cancers. The toxic side effects of cisplatin (peripheralneuropathies, myelo-suppression, gastrointestinal toxicity,nephrotoxicity, and ototoxicity) are well-known. The routineadministration of mannitol, hypertonic saline, and high fluidadministration have largely ameliorated cisplatin-inducednephrotoxicity, leaving ototoxicity as the primary dose-limiting factortoday. Thus, although an increasing number of cancer patients aresurviving modem regimens of chemotherapy, they frequently suffer fromcisplatin-induced hearing impairment.

Cisplatin damages both the auditory and vestibular systems. The primaryototoxic effects of cisplatin appear to occur in the cochlea. Anatomicalchanges occur in both the stria vascularis and the organ of Corti. Theprimary histologic findings include dose-related hair cell degenerationand damage to the supporting cells, and at high doses, total collapse ofthe membranous labyrinth can occur. In the organ of Corti, there is lossof outer and inner hair cells, with a propensity for outer hair cellloss in the basal turn, and alterations in the supporting cells andReissner's membrane. Softening of the cuticular plate and an increasednumber of lysosomal bodies in the apical portion of the outer hair cellhave also been reported.

Noise-induced hearing loss (NIHL) describes a chronic hearing-impairingdisease process that occurs gradually over many years of exposure toless intense noise levels, wherein the damage is to the inner ear,specifically, the cochlea. This type of hearing loss is generally causedby chronic exposure to high intensity continuous noise with superimposedepisodic impact or impulse noise. Both an intense sound presented to theear for a short period of time and a less intense sound that ispresented for a longer time period will produce equal damage to theinner ear. The majority of chronic NIHL is due to occupational orindustrial exposure. However, a non-occupational form of NIHL, calledsocioacusis, may result from gunfire, loud music (via concerts orheadphones), open vehicles such as motorcycles, snowmobiles or tractors,and power tools to name just a few. Although the hearing damage is oftensymmetrical, i.e. both ears are affected, there are cases, such ashearing loss due to frequent target shooting, which result asymmetrichearing loss.

Upon exposure to impulse noise, such as an explosive blast, a patientmay suffer significant tympanic membrane and middle ear damage. Inchronic exposure, which generally occurs at lower intensity levels,middle ear and tympanic membrane damage are unlikely. In noise exposure,the primary and initial damage is generally cochlear, with secondaryneural degeneration of the auditory system occurring over time.Noise-induced hearing loss has been reviewed by K. Campbell in“Essential Audiology for Physicians” (1998), San Diego: SingularPublishing Group, Inc.

Age-related hearing loss, or presbycusis, is a common neurodegenerativedisorder in aged adults. Approximately one in three people in the UnitedStates between the ages of 65 and 74 has hearing loss, and nearly halfof those older than 75 have difficulty hearing (data from NationalInstitution on Deafness and other Communication Disorders). The processof aging interacts with many other factors, such as noise exposure andmiscellaneous ototoxic insults which are hazardous to the receptor haircells (HC) and the spiral ganglion neurons (SGNs) in the cochlea. Inmany cases, it is difficult to distinguish between the effects of agingper se and the effects of other hazardous factors on cell death in thecochlea. Permanent hearing loss resulting from the loss of HCs and SGNsis irreversible because the cells are terminally developed and cannot bereplaced by mitosis.

Otitis media is an inflammation of the middle ear, most commonlyassociated with viral or bacterial infection. A relatively highpercentage of the population, particularly children, are affected. Inchildren, the disease is most often associated with upper respiratoryafflictions which trigger a transudate secretion response in theEustachian tube and middle ear. Bacteria and viruses migrate from thenaso-pharynx to the normally air-filled middle ear via the Eustachiantube, and can cause the Eustachian tube to become blocked, preventingventilation and drainage of the middle ear. Fluid then accumulatesbehind the eardrum, causing pain and inflammation.

Otitis media is the most common cause of hearing loss among children.Although otitis media is readily treated with antibiotics and isordinarily not serious, frequent and/or untreated otitis media maypermanently damage a child's hearing. Fluid remaining in the middle earcan cause repeated bouts of acute otitis media, and if the conditionbecomes chronic it may result in frequent recurrences of acuteinfections. In the more severe forms of otitis media, purulent exudate,toxins and endogenous anti-microbial enzymes accumulate in the middleear, which can cause irreparable damage to sensory-neural and soundconducting structures. Damage to the eardrum, the bones of the ear, orthe auditory nerves caused by such infections can potentially lead topermanent hearing loss. Hearing loss may also result from impairment,damage or destruction of inner ear cochlear hair cells, as damagingsubstances in the middle ear space gain access to the inner ear viadiffusion through the round window membrane.

Izumikawa, M., et. al., “Auditory Hair Cell Replacement and HearingImprovement by Atohl Gene Therapy in Deaf Mammals”, Nat. Med. 11(3),271-276 (2005), discloses that administration of the Atohl gene via anadenovector to the cochlea improved the hearing threshold in guina pigs.Notch signaling pathway inhibitors, and in particular, selective gammasecretase inhibitors are understood to stimulate hair celldifferentiation through their positive effect on expression of theAtohl. (Zheng et al., “Hes1 is a Negative Regulator of Inner Ear HairCell Differentiation”, Development, 2000, 127(21):4551-60; Zine et al.,“Hes1 and Hes5 Activities Are Required for the Normal Development of theHair Cells in the Mammalian Inner Ear”, J Neurosci., 2001,21(13):4712-20; Yamamoto et al., “Inhibition of Notch/RBP-J SignalingInduces Hair Cell Formation in Neonate Mouse Cochleas”, J Mol Med, 2006,84(1):37-45).

Mizutari, K., et. al., “Notch Inhibition Induces Cochlear Hair CellRegeneration and Recovery of Hearing after Acoustic Trauma”, Neuron 77,58-69 (2013), described a study of LY411575 in young mice withnoise-induced hearing loss.

Applicants have identified selected substituted dibenzo azepinederivatives, which are especially suited to the task of the treating(including the prevention, reducing the incidence and/or severity,slowing or halting the progression and reversal) of otic diseases anddisorders of the inner ear.

SUMMARY

The present disclosure provides crystalline forms of a compound selectedfrom Compound I having the formula:

and Compound II having the formula:

In some embodiments the instant crystalline Compound I is characterizedby an x-ray powder diffraction pattern with peaks at 8.2, 13.8, 14.0,18.4, and 20.9±0.15 degrees two-theta.

In some embodiments the instant crystalline Compound I is characterizedby an x-ray powder diffraction pattern with peaks at 4.6, 8.2, 9.2,13.8, 14.0, 18.2, 18.4, 20.9, 23.8, and 27.7±0.15 degrees two-theta.

In some embodiments the instant crystalline Compound I is characterizedby an x-ray powder diffraction pattern with peaks at 3.0, 4.6, 8.2, 9.2,10.4, 13.8, 14.0, 16.4, 18.2, 18.4, 18.8, 19.1, 20.9, 21.5, 22.2, 22.7,23.0, 23.8, 24.3, 24.7, 25.2, 26.5, 26.6, 27.1, 27.7, 28.1, 28.3, 28.6,29.0, 30.0, 31.2, 31.5, 31.8, 32.1, 32.4, 35.1, 35.6, 35.8, 36.4, 36.7,38.4, 38.8, 39.8, 40.5, and 40.8±0.15 degrees two-theta.

In some embodiments the instant crystalline Compound I is furthercharacterized as having a differential scanning calorimetry endothermonset at about 238.5° C. In some embodiments the instant crystallineCompound I is further characterized as having a differential scanningcalorimetry endotherm peak at about 249.3° C.

In some embodiments the instant crystalline Compound II is characterizedby an x-ray powder diffraction pattern with peaks at 8.4, 15.2, 16.0,20.6, and 22.6±0.15 degrees two-theta.

In some embodiments the instant crystalline Compound II is characterizedby an x-ray powder diffraction pattern with peaks at 6.5, 8.4, 15.2,16.0, 19.9, 20.6, 22.6, 24.5, 25.1, and 30.6±0.15 degrees two-theta.

In some embodiments the instant crystalline Compound II is characterizedby an x-ray powder diffraction pattern with peaks at 6.5, 8.4, 10.1,13.1, 14.6, 15.0, 15.2, 16.0, 17.6, 18.0, 18.4, 19.6, 19.9, 20.1, 20.6,20.9, 21.2, 22.2, 22.6, 23.3, 23.5, 23.8, 24.5, 24.9, 25.1, 25.8, 26.1,26.7, 26.8, 27.5, 27.8, 29.6, 30.6, 31.2, 32.3, 32.9, 33.2, 33.9, 34.4,35.4, 36.3, 36.7, 37.3, 37.7, 38.0, 38.9, 40.0, 40.2, 40.8, and41.6±0.15 degrees two-theta.

In some embodiments the crystalline form of Compound II is furthercharacterized as having a differential scanning calorimetry endothermonset at about 173° C.

In some embodiments the crystalline form of Compound II is furthercharacterized as having a differential scanning calorimetry endothermpeak at about 175° C.

In some embodiments the present disclosure provides an aqueouspharmaceutical composition for intratympanic administration comprising:

(1) an active agent selected from the crystalline Compound I andcrystalline Compound II of the embodiments provided above, and(2) a pharmaceutically acceptable aqueous solution comprising:

-   (A) approximately 15% to 25% by weight (w/w) of poloxamer 407; or-   (B) (i) approximately 15% to 25% by weight (w/w) of poloxamer 407    and    -   (ii) approximately 0.5% to 4% by weight (w/w) of hydroxypropyl        methylcellulose having a nominal viscosity of 40-60 cP or grade        80-120 cP; or-   (C) (i) approximately 10%-20% by weight (w/w) of poloxamer 407, and    -   (ii) approximately 0.1%-0.3% by weight (w/w) of Carbopol® 974P;        or-   (D) (i) approximately 0.5% to 8% by weight (w/w) of a hyaluronic    acid; or-   (E) (i) approximately 0.5% to 4% by weight (w/w) of a hyaluronic    acid, and    -   (ii) approximately 5% to 20% by volume of polyethylene glycol        400;        wherein said active agent is present in approximately 0.01% to        about 20% w/v of said aqueous solution.

In some embodiments of the aqueous pharmaceutical composition theaqueous solution comprises:

-   (A) approximately 15% to 25% by weight (w/w) of poloxamer 407; or-   (B) (i) approximately 15% to 25% by weight (w/w) of poloxamer 407    and    -   (ii) approximately 0.5% to 4% by weight (w/w) of hydroxypropyl        methylcellulose having a nominal viscosity of 40-60 cP or grade        80-120 cP; or-   (C) (i) approximately 10%-20% by weight (w/w) of poloxamer 407, and    -   (ii) approximately 0.1%-0.3% by weight (w/w) of Carbopol® 974P.

In some embodiments of the aqueous pharmaceutical composition saidaqueous solution comprises approximately 15% to 25% by weight (w/w) ofpoloxamer 407.

In some embodiments of the aqueous pharmaceutical composition the pH ofsaid aqueous solution is between about 7.0 and 8.0.

In some embodiments of the aqueous pharmaceutical composition saidaqueous solution further comprises a buffering agent.

In some embodiments of the aqueous pharmaceutical composition saidaqueous solution further comprises a buffering agent selected from (i)sodium phosphate monobasic, sodium phosphate dibasic or a combinationthereof; and (ii) tris(hydroxymethyl)aminomethane.

In some embodiments of the aqueous pharmaceutical composition saidactive agent is present in approximately 0.1% to 5% w/v.

In some embodiments of the aqueous pharmaceutical composition saidaqueous solution comprises approximately 15% to 18% by weight (w/w) ofpoloxamer 407.

In some embodiments the aqueous pharmaceutical composition comprises:(1) crystalline Compound I described above, and (2) a pharmaceuticallyacceptable aqueous solution comprising approximately 15% to 25% byweight (w/w) of poloxamer 407, wherein the pH is between about 7.0 and8.0; and wherein said crystalline Compound I is present in approximately0.01% to 20% w/v of said aqueous solution. In some embodiments saidaqueous solution comprises approximately 15% to 18% by weight ofpoloxamer 407. In some embodiments crystalline Compound I is present inapproximately 0.1% to 5% w/v. In some embodiments said aqueous solutioncomprises approximately 15% to 18% by weight of poloxamer 407, andcrystalline Compound I is present in approximately 0.1% to 5% w/v.

In some embodiments the aqueous pharmaceutical composition comprises:(1) crystalline Compound II described above, and (2) a pharmaceuticallyacceptable aqueous solution comprising approximately 15% to 25% byweight (w/w) of poloxamer 407, wherein the pH is between about 7.0 and8.0; and wherein said crystalline Compound II is present inapproximately 0.01% to 20% w/v of said aqueous solution. In someembodiments said aqueous solution comprises approximately 15% to 18% byweight of poloxamer 407. In some embodiments crystalline Compound II ispresent in approximately 0.1% to 5% w/v. In some embodiments saidaqueous solution comprises approximately 15% to 18% by weight ofpoloxamer 407, and crystalline Compound II is present in approximately0.1% to 5% w/v.

In some embodiments the present disclosure provides a method for thetreatment of otic disorders which comprises intratympanic administrationof a therapeutically effective amount of an active agent selected fromthe crystalline compounds disclosed herein to a patient in need thereofto an area at or near the round window membrane in the ear of saidpatient.

In some embodiments of the method of treating otic disorders, the oticdisorder can be hearing loss.

In some embodiments, a method of treating an otic disorder is providedcomprising intratympanic administration of an aqueous pharmaceuticalcomposition described herein to a patient in need of such treatment toan area at or near the round window membrane in the ear of said patient.In some embodiments, the otic disorder can be hearing loss. In someembodiments, the aqueous pharmaceutical composition may be administeredat a frequency of between once a week to once every 3 months.

In some embodiments, a method of treating hearing loss is providedcomprising intratympanic administration to a patient in need of suchtreatment to an area at or near the round window membrane in the ear ofsaid patient of an aqueous pharmaceutical composition comprising (1) anactive agent selected from the crystalline compounds described herein;and (2) an aqueous solution comprising approximately 15% to 18% byweight (w/w) of poloxamer 407, wherein the pH is between approximately7.0 and 8.0; and wherein said active agent is present in approximately0.1% to 5% w/v. In some embodiments the active agent is crystallineCompound I as described herein. In some embodiments the active agent iscrystalline Compound II as described herein.

Some embodiments of the present disclosure are directed to the use of anactive agent selected from crystalline compounds disclosed herein or acomposition comprising the same in the preparation of a medicament forthe treatment of otic disorders. In some embodiments, the medicament isformulated for intratympanic administration to an area at or near theround window membrane in the ear of a patient. In some embodiments ofthe use, the otic disorder can be hearing loss.

Some embodiments of the present disclosure are directed to the use of anactive agent selected from crystalline compounds disclosed herein or acomposition comprising the same in the preparation of an aqueouspharmaceutical composition described herein for use in the treatment ofan otic disorder. In some embodiments, the aqueous pharmaceuticalcomposition is formulated for intratympanic administration to an area ator near the round window membrane in the ear of a patient. In someembodiments, the otic disorder can be hearing loss.

Some embodiments of the present disclosure are directed to the use anactive agent selected from crystalline compounds disclosed herein or acomposition comprising the same in the preparation of an aqueouspharmaceutical composition comprising (1) an active agent selected froma crystalline compound described herein; and (2) an aqueous solutioncomprising approximately 15% to 18% by weight (w/w) of poloxamer 407,wherein the pH is between approximately 7.0 and 8.0; and wherein saidactive agent is present in approximately 0.1% to 5% w/v in the treatmentof hearing loss. In some embodiments, the aqueous pharmaceuticalcomposition is formulated for intratympanic administration to an area ator near the round window membrane in the ear of a patient. In someembodiments the active agent is crystalline Compound I as describedherein. In some embodiments the active agent is crystalline Compound IIas described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts the x-ray powder diffraction diffractogram of crystallineCompound I.

FIG. 2 depicts the Differential Scanning Calorimetry (DSC) curve forcrystalline Compound I.

FIG. 3 depicts the x-ray powder diffraction diffractogram of crystallineCompound II.

FIG. 4 depicts the Differential Scanning Calorimetry (DSC) curve forcrystalline Compound II.

FIG. 5A depicts Guinea Pig PK in the perilymph for an aqueouspharmaceutical composition comprising Compound I in amorphous form andin crystalline form.

FIG. 5B depicts Guinea Pig PK in the cochlea for an aqueouspharmaceutical composition comprising Compound I in amorphous form andin crystalline form.

FIG. 6A depicts Guinea Pig PK in the perilymph for an aqueouspharmaceutical composition comprising Compound II in amorphous form andin crystalline form.

FIG. 6B depicts Guinea Pig PK in the cochlea for an aqueouspharmaceutical composition comprising Compound II in amorphous form andin crystalline form.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

DETAILED DESCRIPTION

The term “Compound I” refers to the compound(2,2,3,3,3-pentafluoropropyl)-carbamic acid(S)-1-((S)-6-oxo-6,7-dihydro-5H-dibenzo[b,d]azepin-7-ylcarbamoyl) ethylester having the structure formula:

The term “Compound II” refers to the compound(2R)-2-fluoro-2-methyl-N—[(S)-5-methyl-6-oxo-6,7-dihydro-5H-dibenzo[b,d]azepin-7-yl]-N′-(2,2,3,3,3-pentafluoropropyl)malonamidehaving the structure formula:

Crystalline forms of Compound I and Compound II may be obtained bydissolving the corresponding amorphous material in an alcohol such asmethanol or ethanol, and subsequently collecting the solids formed. Thecrystalline Compound I and Compound II were characterized using X-raypowder diffraction using a Bruker (Billerica, Mass.) AXS C2 GADDSdiffractometer or a Bruker AXS D8 Advance utilizing copper K-alpha (40kV, 40 mA) radiations. DSC data were collected on a Mettler (Columbus,Ohio) DSC 823E equipped with a 34 position auto-sampler. The instrumentwas calibrated for energy and temperature using certified indium.Typically 0.5-3 mg of each sample, in a pin-holed aluminium pan, washeated at 10° C./min from 25° C. to 300° C. A nitrogen purge at 50ml/min was maintained over the sample.

Crystalline Compound I may be characterized by the Cu K-α x-ray powderdiffraction (XRPD) pattern substantially as shown in FIG. 3.Alternatively, crystalline Compound I may be characterized by the x-raypowder diffraction pattern with peaks at about 8.2, 13.8, 14.0, 18.4,20.9±0.15 degrees two-theta; or by the x-ray powder diffraction patternwith peaks at about 4.6, 8.2, 9.2, 13.8, 14.0, 18.2, 18.4, 20.9, 23.8,27.7±0.15 degrees two-theta; or by the x-ray powder diffraction patternwith peaks at about 3.0, 4.6, 8.2, 9.2, 10.4, 13.8, 14.0, 16.4, 18.2,18.4, 18.8, 19.1, 20.9, 21.5, 22.2, 22.7, 23.0, 23.8, 24.3, 24.7, 25.2,26.5, 26.6, 27.1, 27.7, 28.1, 28.3, 28.6, 29.0, 30.0, 31.2, 31.5, 31.8,32.1, 32.4, 35.1, 35.6, 35.8, 36.4, 36.7, 38.4, 38.8, 39.8, 40.5,40.8±0.15 degrees two-theta. Alternatively, crystalline Compound I maybe characterized as described in the Examples section, infra.

Crystalline Compound II may be characterized by the Cu K-α x-ray powderdiffraction (XRPD) pattern substantially as shown in FIG. 4.Alternatively, crystalline Compound II may be characterized by the x-raypowder diffraction pattern with peaks at about 8.4, 15.2, 16.0, 20.6,22.6±0.15 degrees two-theta; or by the x-ray powder diffraction patternwith peaks at about 6.5, 8.4, 15.2, 16.0, 19.9, 20.6, 22.6, 24.5, 25.1,30.6±0.15 degrees two-theta; or by the x-ray powder diffraction patternwith peaks at about 6.5, 8.4, 10.1, 13.1, 14.6, 15.0, 15.2, 16.0, 17.6,18.0, 18.4, 19.6, 19.9, 20.1, 20.6, 20.9, 21.2, 22.2, 22.6, 23.3, 23.5,23.8, 24.5, 24.9, 25.1, 25.8, 26.1, 26.7, 26.8, 27.5, 27.8, 29.6, 30.6,31.2, 32.3, 32.9, 33.2, 33.9, 34.4, 35.4, 36.3, 36.7, 37.3, 37.7, 38.0,38.9, 40.0, 40.2, 40.8, 41.6±0.2. Alternatively, crystalline Compound IImay be characterized as described in the Examples section, infra.

Crystalline Compound I and Compound II are useful in the preparation ofaqueous pharmaceutical compositions for intratympanic administration asdescribed herein. Crystalline Compound I and Compound II and the aqueouspharmaceutical compositions containing them are useful for the treatmentof otic diseases and disorders.

Pharmaceutical Composition

In one aspect the present disclosure is directed to aqueouspharmaceutical compositions for intratympanic administration comprisingan active agent selected from crystalline Compound I and crystallineCompound II, and a pharmaceutically acceptable aqueous solution. Theactive agents are Notch signaling pathway inhibitors, and in particular,are selective gamma secretase inhibitors.

In some embodiments, the active agent is selected from crystallineCompound I as described and characterized herein. In some embodimentsthe active agent is crystalline Compound II as described andcharacterized herein.

In some embodiments, the crystalline active agent is further processedto provide a more uniform particle size or to control the particle sizeor to reduce the particle size. For example, the initial crystallinematerial may be subject to mechanical impact means such as crushing,grinding, milling (such as ball milling and jet milling), and the liketo provide particles having the desired particle size distribution.

In some embodiments the aqueous pharmaceutical compositions forintratympanic administration comprise provide sustained release of theactive agent in the middle ear. Sustained release formulations typicallyinclude a polymer; suitable polymers for the present disclosure that maybe mentioned include, but are not limited to, gelatin, hyaluronicacid/hyaluronates, chitosan, and polyoxyethylene-polyoxypropylenetriblock copolymers [see e.g., Liu et al., Acta Pharmaceutica Sinica B,2013, 13(2): 86-96, and Swan et al., Adv. Drug Deliv. Rev., 2008,60(15): 1583-1599].

In some embodiments the present aqueous pharmaceutical compositions canbe delivered to the middle ear as a lower viscosity liquid at ambienttemperature which forms in situ a gel having a higher viscosity. Theadvantages of such a composition include (1) the convenience of handlinga liquid at the time of administration, and (2) once gelled in situ aprolonged time of release of the drug at the site of deposit. Increasingthe release time results in a prolonged time of therapeuticeffectiveness and potentially lowered drug dose. Such compositionsadvantageously comprise a thermoreversible gel which has the property ofbeing a liquid at ambient temperature and a gel at about mammalian bodytemperature.

Thermoreversible gels that are suitable for pharmaceutical applicationmay be prepared using polymers including poly(lactic acid)-poly(ethyleneglycol) (PLA-PEG) or triblock copolymers of PEG-PLGA-PEG. Achitosan-glycerolphosphate solution is able to form a reversiblethermosetting gel. Addition of sugar-based phosphates transformschitosan into a thermo-reversible gel drug delivery system. A commongroup of thermoreversible gels is polyoxyalkylene based polymers, suchas the polyoxyethylene-polyoxypropylene triblock copolymers knowngenerically as poloxamers. Poloxamers in aqueous solutions exhibitthermoreversible properties that are advantageous for the presentdisclosure. Thus, aqueous solutions of poloxamer can transition fromliquid state to gel state with rising temperature. The liquid-geltransition temperature may be adjusted by varying the concentration ofthe poloxamer as well as addition of other excipients such as viscositymodifying agents; thus solutions of poloxamer may be prepared that arein liquid state at room temperature or below, and transition to gelstate at body temperature. In one embodiment of the present composition,the thermoreversible gel is poloxamer 407 (e.g., Pluronic® F127 marketedby BASF, Florham Park, N.J.).

In some embodiments the present aqueous pharmaceutical composition forintratympanic administration comprising an active agent selected fromcrystalline Compound I and crystalline Compound II, and apharmaceutically acceptable aqueous solution comprising poloxamer 407.The poloxamer may be present in a concentration from about 15 to about25% by weight. In some embodiments the poloxamer 407 concentration isfrom about 15 to about 18% by weight. In some embodiment the poloxamer407 concentration is from about 16 to about 17% by weight. In someembodiments the poloxamer is present in approximately 15 or 16 or 17 or18% by weight. In some embodiments the pharmaceutical compositions ofthe present disclosure comprising poloxamer 407 may optionally includehydroxypropyl methylcellulose (HPMC) having a nominal viscosity of 40 to120 cP, and in an amount approximately 0.5% to 4% by weight.

In some embodiments the composition of the present disclosure is anaqueous pharmaceutical composition for intratympanic administrationcomprising an active agent selected from crystalline Compound I andcrystalline Compound II, and a pharmaceutically acceptable carriercomprising (a) approximately 0.5% to 8% by weight of a hyaluronic acid;or (b) (i) approximately 0.5% to 4% by weight of a hyaluronic acid, and(ii) approximately 5% to 20% by volume of polyethylene glycol 400(PEG400).

In the aqueous pharmaceutical compositions for intratympanicadministration the concentration of the active agent selected fromcrystalline Compound I and crystalline Compound II is generally fromabout 0.01% w/v to 20% w/v. This range includes the sub-range of about0.05 w/v to about 15 w/v, about 0.1 w/v to about 10 w/v, about 0.1% w/vto about 5% w/v. In some embodiments the concentration of the activeagent is from about 0.5% w/v to about 5% w/v. In some embodiments theconcentration of the active agent is from about 0.5 to about 4% w/v. Insome embodiments the concentration of the active agent is from about 1to about 5% w/v. In some embodiments the concentration of the activeagent is from about 1 to about to about 4%. In some embodiment theconcentration of the active agent is about 0.5, 1.0, 1.5, 2.0, 2.5, 3.0,3.5, 4.0, 4.5 or 5% w/v. In some embodiment the concentration of theactive agent is about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 or 1%w/v.

The composition disclosed herein may contain any conventional non-toxicpharmaceutically-acceptable excipients. In some embodiments, the pH ofthe composition is between about 6 to 8, or about 6 to 7, or about 7 to8. In some embodiments the composition may include a buffer such asmonosodium phosphate or disodium phosphate or a combination thereof andmay be phosphate buffered saline (PBS), or a buffer such astris(hydroxymethyl)aminomethane (TRIS). The amount of buffer may be fromabout 0.1 to about 0.5% by weight.

In some embodiments the aqueous pharmaceutical composition of thepresent disclosure may include a viscosity modifier such as Carbopol®974P (Lubrizol Advanced Materials, Cleveland, Ohio). In some embodimentsthe aqueous pharmaceutical composition for intratympanic administrationcomprises an active agent selected from crystalline Compound I andcrystalline Compound II, and a pharmaceutically acceptable carriercomprising poloxamer 407 and a viscosity modifier such as Carbopol®974P. In some embodiments poloxamer 407 is present in approximately 10%to 20% by weight, and Carbopol® 974P is present in about 0.1% to about0.3% by weight. In some embodiments the active agent is crystallineCompound I or crystalline Compound II. Other common excipients mayinclude preservatives such as methylparaben, as well as sodium chlorideto provide isotonicity. The compositions are formulated such that theyprovide sustained release of the active agent for a period sufficient toeffectuate gamma secretase inhibition. The sustained inhibition of gammasecretase minimizes the frequency of administration to once weekly,biweekly, monthly, bimonthly, quarterly, semiannually, annually, etc. Insome embodiments, the dosing frequency is once every two weeks, or twicea month, or monthly or once every other month, or quarterly.

The aqueous pharmaceutical composition disclosed herein comprising anactive agent selected from crystalline Compound I and crystallineCompound II and a carrier may be prepared using conventional methodssuch as described in the Examples, and may be packaged for single doseuse such as in a syringe or for multiple dose such as in a vial.Alternatively, the active agent component and the aqueous solutioncomponent may be packaged separately, in separate compartments or inseparate containers, and are mixed prior to administration.

Illustrative examples of compositions suitable for local inner earadministration of compounds of the present disclosure are provided inthe Examples section, infra.

Method of Treatment

In one aspect the present disclosure is directed to methods for thetreatment of otic disorders comprising intratympanic administration of atherapeutically effective amount of an active agent selected fromcrystalline Compound I and crystalline Compound II to a patient in needthereof to an area at or near the round window membrane in the ear ofsaid patient. The term “otic disorders” generally relates to conditionsresulting from cochlear hair cell loss including, but is not limited to,hearing loss and deafness, as well as conditions associated withvestibular dysfunction, which may be manifested through symptoms such asdizziness, imbalance, vertigo, nausea, and fuzzy vision. Hearing loss ordeafness may be due to ototoxic chemicals, excessive noise, and aging.

As used herein, the term “treatment” or “therapy” or “treating” and thelike includes controlling, alleviating, reversing, or slowing theprogression of the condition being treated; for example, reduction orhalting of further hearing loss due to the above or other factors; andthe restoration of hearing following the partial or profound hearingloss due to the above or other factors. Treatment also includesprevention (e.g., delaying the onset of or reducing the risk ofdeveloping) of hearing loss as well as prophylactic use such as before,during or after receiving ototoxic chemicals such as an aminoglycosideantibiotic such as gentamicin or a platinum chemotherapeutic agent suchas cisplatin.

As used herein, the term “therapeutically effective amount” refers to anamount of the active agent sufficient to elicit a desired or beneficialeffect in the disease or disorder being treated; for prophylaxis, itrefers to an amount of the active agent sufficient to prevent the onsetor lessen the effect of the disease or disorder. The amount to be useddepends on the active agent chosen, the severity of the disease ordisorder being treated, the route of administration and patientcharacteristics such as age.

In the present disclosure the active agent is administered to the ear byintratympanic injection into the middle ear, inner ear, or cochlea orcombinations thereof. Intratympanic is also referred to astranstympanic, and both terms are used interchangeably herein.Intratympanic injection is the technique of injecting a therapeuticagent through the tympanic membrane into the middle ear where thetherapeutic agent may diffuse across the round window membrane to reachthe inner ear. It has been used in clinical practice for many years andis a relatively minor intervention which can be carried out in adoctor's office. For repeated injections, a middle ear ventilation tubemay be inserted into the tympanic membrane, through which the medicationcan be administered into the middle ear space behind the tympanicmembrane into the middle and/or inner ear. In one embodiment, the activeagent is administered intratympanically to an area near or onto theround window membrane.

In some embodiments of the present method the active agent isadministered in an aqueous pharmaceutical composition comprising athermoreversible gel; such compositions are liquid at room temperature(for ease of administration) and turn into gel at body temperature suchthat the pharmaceutical composition does not quickly drain through theEustachian tube. In some embodiments the present method utilizes thepharmaceutical compositions described hereinbelow.

Doses for local inner administration of crystalline Compound I orcrystalline Compound II include from about 0.06 mg to about 100 mg. Thisrange includes the sub-range of about 0.1 mg to about 90 mg, 0.25 mg toabout 80 mg, 0.4 mg to 70 mg, 0.6 mg to 60 mg, 0.80 mg to 50 mg, 1.0 mgto 40 mg, 2 mg to 30 mg, 3 mg to 20 mg. The doses may be administered inan aqueous pharmaceutical composition comprising an aqueous solution,wherein the volume of aqueous solution to be administered comprises arange of about 100 μL to about 500 μL in volume. This range of volumesincludes a sub-range of about 100 μL to 150 μL, 100 μL to 200 μL, 100 μLto 250 μL, 100 μL to 300 μL, 100 μL to 350 μL, 100 μL to 400 μL, 100 μLto 450 μL and 100 μL to 500 μL. This range of volumes also includes asub-range of about 200 μL to 250 μL, 200 μL to 300 μL, 200 μL to 350 μL,200 μL to 400 μL, 200 μL to 450 μL and 200 μL to 500 μL. This range ofvolumes also includes a sub-range of about 300 μL to 350 μL, 300 μL to400 μL, 300 μL to 450 μL and 300 μL to 500 μL. This range of volumesalso includes a sub-range of about 400 μL to 450 μL and 400 μL to 500μL. Due to physical limitations, the proportion of the active agent tothe aqueous pharmaceutical composition is contemplated to be 20% byweight or less.

In one aspect the compounds disclosed herein may be co-administered withone or more additional agents such as a steroid; for example,dexamethasone. In certain embodiments, the additional agents may beadministered separately from crystalline Compound I or crystallineCompound II (e.g., sequentially, e.g., on different overlappingschedules). In other embodiments, these agents may be part of a singledosage form, mixed together with Compound I or Compound II in a singlecomposition. In still another embodiment, these agents can be given as aseparate dose that is administered at about the same time crystallineCompound I or crystalline Compound II is administered. When thecompositions disclosed herein include a combination of a crystallineCompound I or crystalline Compound II and one or more additionaltherapeutic or prophylactic agents, both the compound and the additionalagent can be present at dosage levels of between about 1 to 100%, andmore preferably between about 5 to 95% of the dosage administered in amonotherapy regimen.

Biological Function

The utility of the present disclosure can be demonstrated by one or moreof the following methods or other methods known in the art:

A. Otosphere Differentiation Assay

To determine compound activity in inducing mouse hair celldifferentiation, otospheres were generated from the mouse organ of Cortias described in Oshima et al., Auditory and Vestibular Res Methods,2009. Briefly, sensory epithelia from the neonatal organ of Corti wereisolated, treated with trypsin, and gently dissociated. Dissociatedcells were then transferred to a low adhesion well in DMEM/F12 mediacontaining 1× B27 and N2 supplements (Invitrogen Life Sciences,Carlsbad, Calif.), EGF, IGF-1 and bFGF for sphere formation. After 3days of sphere formation, spheres were isolated by centrifugation andtransferred to fibronectin coated plates and allowed to adhere overnightin media lacking growth factors. Adherent spheres were then treated withthe test compound at concentrations ranging from 10⁻⁵ to 10⁻¹⁰ M for 4d.RNA was then harvested with an RNeasy kit (Qiagen®, Hilden, Germany) andwere analyzed using quantitative PCR performed using gene specificprimers against Atohl and Myo7a using Rp119 as a housekeeping gene.Values were subsequently analyzed using the ΔΔCt method. Those ofordinary skill would understand that the ΔΔCt method is commonly used inthe art of PCR.

B. Mouse Organ of Corti Explant Assay

(a) Notch Inhibition.

Neonatal mouse explants were used to ascertain inhibition of the Notchpathway and to test compound ability to generate hair cells in an exvivo system. Briefly, organ of Corti were dissected from postnatal day 3mice and plated onto 4-well chambers coated with poly-L-lysine andfibronectin. Explants were plated directly into DMEM media containing10% fetal bovine serum, B27 supplement with and without test compound.To ascertain Notch inhibition, RNA was extracted 24 h after compoundaddition using an RNeasy kit, and quantitative PCR performed using geneprimers specific against Hes5. Rp119 was used as a housekeeping gene andvalues analyzed using the ΔΔCt method.

(b) Hair Cell Induction.

For hair cell induction studies, explants were generated and treatedwith the compound as above; however, explants were treated for 3-5 dayswith media replenished daily in the presence or absence of compound.Explants were then fixed with paraformaldehyde and immunostained withantibodies against MYO7A, SOX2 and counterstained withAlexa647-phalloidin and Hoechst. Images were taken on a Nikon N2confocal system using NIS-Elements software (Nikon, Melville, N.Y.,USA). MYO7A/phalloidin positive hair cells were then quantified andcompared against vehicle treated groups.

C. Human Neural Stem Cell Assay

Neural stem cells (NSC) were derived from embryonic stem cells using apublished protocol (Yuan et al., Mar. 2, 2011, PLoS ONE, 6(3):e17540).Cells were sorted and characterized at passage 3 and were expanded.Cells were then frozen at passage 5. Cells were maintained in NSC media(DMEM/F12, N2 (1×), B27(1×) (Invitrogen), and Pen/Strep (1×) (LifeTechnologies) with 20 ng/ml bFGF (BD Bioscience/Corning)). On day 1,cells were plated in 96 well plates that have been previously coatedwith poly-ornithin and laminin, 60,000 cells/well in 100 μl of media. Onday 2, spent media was removed, and 180 μl of fresh media was added tothe cells. Later that same day (day 2), cells were treated with 20 μl ofNSC media containing test compounds (7 point CRC). On day 3, spent mediawas removed and 140 μl of RLT/bME was added to the cells. RNA wasextracted using the QiaCube (Qiagen®, Germantown, Md., USA) using thetotal RNA extraction+DNAse protocol. RNA was then reverse-transcribed tocDNA using iScript (Bio-Rad, Hercules, Calif., USA). cDNA was then usedfor real-time PCR analysis using iTaq Sybergreen (BioRad). Expression ofAtohl, Hes5, Hes1, Myosin7a genes was evaluated using CFX96 or CFX384(Bio-Rad). HPRT1 was used as a reference gene. Analysis was done usingMicrosoft® Excel® and CBIS (ChemInnovation Software, Inc., San Diego,Calif., USA).

The above procedure was followed to determine an EC₅₀ for each compound.

hNSC Atoh1 EC₅₀ hNSC HES1 IC₅₀ hNSC HES5 IC₅₀ Compound (μM) (μM) (μM) I0.625 0.242 0.288 II 0.023 0.023

D. Human Embryonic Stem Cell Differentiation to Hair Cell-Like Cells

This protocol was designed to differentiate human embryonic stem cells(hESCs) into otic progenitor cells and further differentiate theprogenitor cells into hair cell-like cells. The hESCs were maintained onmitomycin C-treated mouse embryonic fibroblasts (MEFs) in knockoutDMEM/F12 media supplemented with 20% knockout serum, lx non-essentialamino acids, 1× 1-glutamine, 1× β-mercaptoethanol (bME) and 8-10 ng/mlhuman bFGF. The hESCs were passaged using collagenase onto new MEFsuntil they were ready to begin differentiation, in which case they werepassaged onto matrigel coated plates in MEF-conditioned mediasupplemented with 8 ng/ml bFGF for 3-5 days.

Human ES cells were differentiated using a published protocol (Ronaghi Met al., Stem Cells Dev. 2014, 1275-84). With the exception thatAggreWells plates (from Stem Cell Technology, Vancouver, Calif.) wereused to generate embryoid bodies (EBs) in the first 6 days of theprotocol. Treatment with potential Atohl or hair cell inducers wasadministered to the cells on day 34-39. On day 39, the cells were lysedfor protein, fixed for imaging, or extracted for RNA as described below.

(a) Western Blot Analysis of Myosin7a:

Protein was simultaneously extracted from two experimentally similarwells using RIPA buffer. The protein concentration was determined usingan established protocol, and a western blot was done with thedifferentiated protein samples, a sample of the hESCs of the samepassage, a marker and a positive control cell sample that expressesMyosin7a (Y79 cells). The membrane was incubated with Myosin7a antibodyas well as a α-actin antibody as loading control. Once the blot wasimaged, Licor system was used to quantify the Myosin7a and α-actin bandsfor comparative analysis.

(b) Immunocytochemistry:

The wells were briefly rinsed with DPBS and then fixed for 10 minuteswith 4% paraformaldehyde, followed by a 10 minute incubation with 100 mMglycine in DPBS. The wells were washed 3 times with DPBS, permeabilizedfor 10 minutes with 0.2% TritonX-100, and then blocked for one hour withbuffer containing 0.1% BSA and 0.2% TritonX-100. Primary antibodies forMyosin7a and Sox2 were added and kept overnight at 4° C. The followingday the wells were washed 3 times with DPBS and secondary antibodieswere added and incubated in the dark at room temperature for 2 hours.The wells were washed 2 times and the cells were stained with488-Phalloidin for 10 minutes in the dark at room temperature. The wellswere washed 2 times with DPBS and Hoechst stain was added to the wellsand incubated for 10 minutes in the dark at room temperature. The wellswere washed a final 3 times and were imaged using the GE Healthcare LifeSciences (Pittsburgh, Pa., USA) InCell 2200 automated imaging system.

(c) PCR:

RNA was extracted and isolated using RNA isolation kit from Qiagen®(including DNAse treatment). RNA concentration was determined using theNano-Drop. cDNA was made using iScript (Bio-Rad) on CFX96 (BioRad). Thequantity of target genes such as Myosin7a, Atohl, Hes5, Axin2 and GAPDH,was determined using the iTaq PCR kit (Bio-Rad) on a CFX-96 or CFX-384real-time PCR (BioRad). All primers were from OriGene (Rockville, Md.)or Integrated DNA Technologies (IDT, Coralville, Iowa).

E. Guinea Pig PK

Male Hartley guinea pigs (300-350 g) were anesthetized with ketamine andxylazine. Thirty microliters of an aqueous pharmaceutical composition ofthe instant embodiments was delivered transtympanically to deposit thedrug to the round window membrane. Delivery was unilateral. The animalswere placed in a warm chamber in a lateral recumbent position keepingthe dosed ear side up until they recover from anesthesia.

At various timepoints after administration, the animals were euthanizedby CO₂ inhalation. Blood and CSF were collected and stored at −80° C.The animals were decapitated, the temporal bones removed and the bullaopened to expose the otic capsule. Ipsilateral and contralateralperilymph were collected from the apex using a microcapillary tube. Theipsilateral cochlea was removed from the otic capsule and stored at −80°C. All tissues collected were analyzed using LC/MS/MS for test compoundconcentration as follows. Analytical standards were prepared by spikingknown concentrations of the test compound stock solutions into matricessuch as plasma or artificial CSF. Fixed amounts of tissues collected andspiked standards were precipitated with acetonitrile containingbuspirone as an internal standard. The precipitated samples werecentrifuged at 4000 g for 10 minutes at 4° C. The supernatants wereanalyzed using LC-MS/MS. The LC-MS/MS system was set up using the ABSciex 4000 Qtrap (AB Sciex, Framingham, Mass.) equipped with Agilent1200 series HPLC and CTC PAL Autosampler (Agilent Technologies, SantaClara, Calif.).

F. Functional Pharmacodynamic

(a) Surgical Delivery of Test Compound to the Round Window Membrane.

Surgery was performed on naïve mice or mice with noise orpharmacologically-damaged ears. The animals were anesthetized withisoflurane and an 8 mm retroauricular incision was made to the lowercaudal edge of the pinna. The skin was retracted and the fatty tissuewas blunt dissected away from where the facial nerve and muscle cometogether. The muscle was retracted to reveal an area in the tympanicbulla where the bone was thin. A 30 g needle was used to drill a hole inthe exposed thin portion of the otic bulla. A Hamilton syringe equippedwith a 32 g blunt needle was inserted into the opening of the oticbulla. The drug formulation was delivered by injection and the needleremoved. Wound closure was made with tissue glue.

(b) Functional PD.

At various time points after drug delivery, typically 24 hours, the micewere euthanized by C02 exposure and the temporal bone was removed intoice cold RNAlater® (Thermo Fisher Scientific, Waltham, Mass., USA). Theotic capsule was carefully dissected from the temporal bone, placed intoa clean tube containing TriZol (Zymo Research, Irvine, Calif., USA),immediately flash frozen in liquid nitrogen and stored at −80° C. untilRNA isolation. RNA was isolated using a Qiagen® RNA MiniElute kitaccording to manufacturer's instruction. cDNA was generated and PCR wasperformed on specific primers using BioRad iTaq.

G. Hair Cell Induction

In mice, the instant drug formulation was surgically delivered to theround window as described in Section F, above. In guinea pigs, theinstant drug formulation was delivered via transtympanic injection tothe round window niche as described in Section E, above. Seven to 14days after drug delivery, the animals were euthanized with ketamine andxylazine, their whole body was perfused with 10% neutral bufferedformalin and the temporal bones were removed and stored in formalin. Forguinea pigs, when cochlea whole mounts were to be prepared, intrascalarperfusion was performed to fully bathe the cochlea in formalin.Midmodiolar sections or cochlea whole mounts were prepared and stainedto identify hair cells.

H. Auditory Brainstem Response (ABR)

Naïve mice or mice at various times after either noise orpharmacological deafening were anesthetized withketamine/xylazine/acepromazine and the auditory brainstem response wasdetermined in both ears using a Tucker Davis (Alachua, Fla.) RZ6apparatus. The mice were exposed to clicks or pure tones of 4, 8, 16, 24and 32 kHz at 90-10 dB in 10 dB descending steps and the hearingthreshold was determined.

The results of the above experiment performed using the formulations ofExamples 3(c) and 3(d) are provided in the Table below:

ABR Threshold Improvement (dB) 16 kHz 24 kHz 32 kHz Compound I 7 10 8Compound II 8 11 7

Guinea pigs, naïve or after pharmacological deafening, were anesthetizedwith ketamine/xylazine. The auditory brainstem response (ABR) wasdetermined bilaterally using a Tucker Davis RZ6 apparatus. The guineapigs were exposed to clicks or pure tones of 4, 8, 16 or 24 kHz at 90-10dB in 10 dB descending steps and the hearing threshold was determined.

EXAMPLES Example 1. Preparation of Crystalline Compound I

Compound I is disclosed in Flohr et al. U.S. Pat. No. 7,166,587, issuedJan. 23, 2007, and the synthetic procedure disclosed therein, whenfollowed, produces Compound I as an amorphous material. AmorphousCompound I (2 g) was suspended in MeOH (60 mL) and the suspension washeated to 65 degrees C. to yield a clear solution. The solution wasallowed to cool and remain at ambient temperature for 18 hours. Duringthat time crystallization occurred. The reaction was filtered and thesolid collected and dried under vacuum to yield a white solid (1 g)which was determined to be crystalline, and is characterized by theX-ray powder diffraction peaks in Table 1 and the pattern displayed inFIG. 1. DSC Endotherm onset occurs at 238.5° C. as shown in FIG. 2.

TABLE 1 XRPD peak locations for crystalline Compound I Angle IntensityRelative Peak (°2θ) (counts) Intensity 1 3.0 266 11.4 2 4.6 1173 50.3 38.2 2332 100.0 4 9.2 1038 44.5 5 10.4 410 17.6 6 13.8 1400 60.0 7 14.01342 57.5 8 16.4 859 36.8 9 18.2 1281 54.9 10 18.4 1352 58.0 11 18.8 1928.2 12 19.1 185 7.9 13 20.9 1427 61.2 14 21.5 152 6.5 15 22.2 193 8.3 1622.7 335 14.4 17 23.0 548 23.5 18 23.8 840 36.0 19 24.3 296 12.7 20 24.7144 6.2 21 25.2 145 6.2 22 26.5 143 6.1 23 26.6 151 6.5 24 27.1 112 4.825 27.7 680 29.2 26 28.1 147 6.3 27 28.3 127 5.4 28 28.6 202 8.7 29 29.086 3.7 30 30.0 87 3.7 31 31.2 459 19.7 32 31.5 139 6.0 33 31.8 371 15.934 32.1 279 12.0 35 32.4 121 5.2 36 35.1 137 5.9 37 35.6 146 6.3 38 35.8172 7.4 39 36.4 137 5.9 40 36.7 166 7.1 41 38.4 98 4.2 42 38.8 136 5.843 39.8 362 15.5 44 40.5 133 5.7 45 40.8 353 15.1

Example 2. Preparation of Crystalline Compound II

Compound II is disclosed in Flohr et al. U.S. Pat. No. 7,160,875, issuedJan. 9, 2007, and the synthetic procedure disclosed therein, whenfollowed, produces Compound II as an amorphous material. AmorphousCompound II (432 mg) was weighed into a 20 mL vial and dissolved in EtOH(2.15 mL, 5 volumes). The resulting clear solution was checked after 30minutes and a white powder was observed to have formed. This suspensionwas agitated for approximately 16 hours at room temperature and thesolid was isolated by filtration and was dried for 16 hours at 40° C./3mbar to give a powdery white solid (315 mg, 73% yield) which wasdetermined to be crystalline, and is characterized by the XRPD peaks inTable 2 and the pattern displayed in FIG. 3. DSC endotherm onset beginsat 173° C. (melt) as shown in FIG. 4.

TABLE 2 XRPD peak locations for crystalline Compound II. Angle IntensityRelative Angle Intensity Relative Peak (°2θ (counts) Intensity Peak(°2θ) (counts) Intensity 1 6.5 711 33.7 26 25.8 84 4.0 2 8.4 737 35.0 2726.1 155 7.4 3 10.1 85 4.0 28 26.7 141 6.7 4 13.1 277 13.1 29 26.8 1587.5 5 14.6 101 4.8 30 27.5 231 11.0 6 15.0 353 16.7 31 27.8 79 3.7 715.2 2108 100.0 32 29.6 171 8.1 8 16.0 912 43.3 33 30.6 498 23.6 9 17.6170 8.1 34 31.2 119 5.6 10 18.0 129 6.1 35 32.3 79 3.7 11 18.4 286 13.636 32.9 100 4.7 12 19.6 168 8.0 37 33.2 191 9.1 13 19.9 592 28.1 38 33.9219 10.4 14 20.1 202 9.6 39 34.4 77 3.7 15 20.6 1146 54.4 40 35.4 29313.9 16 20.9 179 8.5 41 36.3 193 9.2 17 21.2 126 6.0 42 36.7 178 8.4 1822.2 245 11.6 43 37.3 234 11.1 19 22.6 987 46.8 44 37.7 103 4.9 20 23.3342 16.2 45 38.0 122 5.8 21 23.5 162 7.7 46 38.9 96 4.6 22 23.8 253 12.047 40.0 114 5.4 23 24.5 476 22.6 48 40.2 100 4.7 24 24.9 210 10.0 4940.8 210 10.0 25 25.1 540 25.6 50 41.6 139 6.6

Examples 3(a) and 3(b) Preparation of Formulation A-1

Example 3(a)—To 128 mL sterile filtered water was added 0.9 g sodiumchloride, 0.59 g sodium phosphate dibasic, and 0.17 g sodium phosphatemonobasic. The solution was stirred at ambient temperature and 27.2 gpoloxamer 407 was added and stirred overnight to yield a clear solution.2 mL of the solution described above was added to 40 mg of crystallineCompound I and the suspension was stirred on an ice bath for 20 minutesto yield a homogeneous suspension.

Example 3(b)—A homogeneous suspension containing 2% w/v crystallineCompound II was prepared in the same manner as described above.

Examples 3(c) and (d) of Formulation A-2

Example 3(c)—To 129 mL sterile water was added 0.96 g sodium chloride,0.59 g sodium phosphate dibasic, and 0.14 g sodium phosphate monobasic.The solution was stirred at ambient temperature and 25.6 g poloxamer 407was added and stirred overnight to yield a clear solution. The solutionwas sterile filtered and 1 mL of the solution described above was addedto 20 mg of crystalline Compound I and the suspension was vortexed for60 minutes to yield a homogeneous suspension.

Example 3(d)—A homogeneous suspension containing 2% w/v crystallineCompound II was prepared in the same manner as described above.

Example 4. Preparation of Formulation B

To 3 mL of sterile filtered 0.1 M pH7 TRIS buffer was added 0.6 g ofpoloxamer 407 and this was stirred overnight at 4° C. to form a clear,homogeneous solution. To this solution was then added 60 mg ofcrystalline Compound I and 3 mg of methylparaben. The resultingsuspension was stirred at 4° C. for 16 hours and stored at 4° C. untildosing.

Examples 5(a), 5(b), 5(c) and 5(d). Preparation of Formulation C

Example 5(a)—To 10 mL of sterile filtered 0.1 M pH 7 TRIS buffer wasadded 1.8 g of poloxamer 407 and this was stirred overnight at 4° C. toform a clear, homogeneous solution. To 3 mL of this solution was thenadded 60 mg of crystalline Compound I, and the suspension was stirredovernight at 4° C. to form a homogeneously-distributed suspension.Finally, 90 mg of hydroxypropyl methylcellulose (HPMC) (40-60 cp)(Sigma-Aldrich, St. Louis, Mo.) and 3 mg of methylparaben were added andthe suspension was stirred at 4° C. for 16 hours and stored at 4° C.until dosing.

Example 5(b)—A homogeneous suspension containing 2% of amorphousCompound I was prepared following the procedure described above.

Example 5(c)—A homogeneous suspension containing 2% of crystallineCompound II was prepared following the procedure described above.

Example 5(d)—A homogeneous suspension containing 2% of amorphousCompound II was prepared following the procedure described above.

Example 6. Preparation of Formulation D

To 3 mL of sterile filtered 0.1 M pH 7 TRIS buffer was added 0.54 g ofpoloxamer 407 and this was stirred overnight at 4° C. to form a clear,homogeneous solution. To this solution was then added 60 mg ofcrystalline Compound I and the suspension was stirred overnight at 4° C.to form a homogeneously-distributed suspension. Finally, 90 mg of HPMC(40-60 cp), 3 mg of methylparaben and 6 mg of Carbopol® 974P (LubrizolAdvanced Materials, Cleveland, Ohio) were added and the suspension wasstirred at 4° C. for 16 h and stored at 4° C. until dosing.

Example 7. Preparation of Formulation E

To 3 mL of sterile filtered 0.1 M pH 7 TRIS buffer was added 0.54 g ofpoloxamer 407 and this was stirred overnight at 4° C. to form a clear,homogeneous solution. To this solution was then added 60 mg ofcrystalline Compound I and the suspension was stirred overnight at 4° C.to form a homogeneously-distributed suspension and stored at 4° C. untildosing.

Example 8. Preparation of Formulation F

To 10 mL of sterile filtered phosphate buffer saline was added 100 mg ofhyaluronic acid and this was stirred at the ambient temperatureovernight to form a clear, homogeneous solution. To 60 mg of crystallineCompound I was added 0.6 mL of PEG400 (Sigma-Aldrich, St. Louis, Mo.).The suspension was stirred at ambient temperature. 3 mL of thehyaluronic acid solution described above was added to the Compound I andPEG400 suspension. The suspension was stirred at ambient temperature toform a homogeneously-distributed suspension.

Example 9. Preparation of Formulation G

To 10 mL of sterile filtered phosphate buffer saline was added 200 mg ofhyaluronic acid and this was stirred at the ambient temperatureovernight to form a clear, homogeneous solution. To 60 mg of crystallineCompound I was added 0.15 mL of PEG400. The suspension was stirred atambient temperature. 3 mL of the hyaluronic acid solution describedabove was added to the Compound I and PEG400 suspension. The suspensionwas stirred at ambient temperature to form a homogeneously-distributedsuspension.

Examples 10(a) and 10(b). Preparation of Formulation H

Example 10(a)—To 10 mL of sterile filtered phosphate buffer saline wasadded 150 mg of hyaluronic acid and this was stirred at the ambienttemperature overnight to form a clear, homogeneous solution. To 60 mg ofcrystalline Compound I was added 0.3 mL of PEG400. The suspension wasstirred at ambient temperature. 3 mL of the hyaluronic acid solutiondescribed above was added to the Compound I and PEG400 suspension. Thesuspension was stirred at ambient temperature to form ahomogeneously-distributed suspension.

Example 10(b)—A homogeneous suspension containing 2% of crystallineCompound II was prepared following the procedure described above.

Example 11. Preparation of Formulation I

To 5 mL of sterile filtered phosphate buffer saline was added 50 mg ofOligopeptide (Corning® PuraMatrix™ Peptide Hydrogel, Corning, N.Y.) andthis was stirred at the ambient temperature for 2 hours to form a clear,homogeneous solution. To 60 mg of crystalline Compound I was added 0.3mL of PEG400. The suspension was stirred at ambient temperature. 3 mL ofthe Oligopeptide solution described above was added to the Compound Iand PEG400 suspension. The suspension was stirred at ambient temperatureto form a homogeneously-distributed suspension.

Example 12. Preparation of Formulation J

To 5 mL of sterile filtered phosphate buffer saline was added 500 mg ofHPMC (40-60 cp) and this was stirred at the ambient temperature forovernight to form a clear, homogeneous solution. To 60 mg of crystallineCompound I was added 0.3 mL of PEG400. The suspension was stirred atambient temperature. 3 mL of the HPMC solution described above was addedto the Compound I and PEG400 suspension. The suspension was stirred atambient temperature to form a homogeneously-distributed suspension.

Example 13. Guinea Pig PK

Liquid compositions described herein were evaluated using the methoddescribed in Part E of the Biological Function section provided above.The liquid compositions prepared as described in Example 5(a)-5(d) wereeach drawn into a 1 mL syringe. Using the filled 1 mL syringe, theliquid composition was back-filled at 5° C. into a 100 μL Hamiltonsyringe adapted with 28 gauge needle. The Hamilton syringe was thenallowed to warm to room temperature.

Male Hartley guinea pigs (300-350 g) were anesthetized with ketamine andxylazine. Thirty microliters of the above liquid composition weredelivered transtympanically to deposit the drug to the round windowmembrane. The delivery was unilateral. The animals were placed in a warmchamber in a lateral recumbent position keeping the dosed ear side upuntil they recovered from anesthesia.

At various timepoints after administration, the animals were euthanizedby CO₂ inhalation. Blood and cerebrospinal fluid were collected andstored at −80° C. The animals were decapitated, the temporal bonesremoved and the bulla were opened to expose the otic capsule.Ipsilateral and contralateral perilymph were collected from the apexusing a microcapillary tube. The ipsilateral cochlea was removed fromthe otic capsule and was stored at −80° C. All tissues collected wereanalyzed using LC/MS/MS as described in Part E of the BiologicalFunction section above.

The concentrations of Compound I and Compound II were measured usingLC/MS/MS in both the perilymph fluid and the cochlea tissue after atranstympanic injection of an instant formulation of either thecrystalline form or the amorphous form at various time points. Whendosed as the amorphous form, the concentration of Compound I in theperilymph and the cochlea was above the human NSC EC₅₀ for Atohl at 1day and 7 days. The concentration of Compound 1 when dosed as thecrystalline form was above the NSC EC₅₀ from day 1 to day 28. When dosedas the amorphous form, the concentration of Compound II in perilymph andcochlea was above the human NSC EC₅₀ for Atohl at 1 day and 7 days. Theconcentration of Compound II when dosed as crystalline form was abovethe human NSC EC₅₀ Atohl from day 1 to day 42. Concentration of theinstant compounds in the perilymph and/or cochlea tissue was above thehuman NSC EC₅₀ for Atohl, an indicator that the subject compounds may beefficacious in hair cell regeneration and hearing restoration in human.Surprisingly, the pK results show formulations containing crystallineCompound I and crystalline Compound II provide longer exposure ofCompound I and Compound II to the inner ear than formulations containingthe respective amorphous forms. Table 3 below lists the results for thestudies using aqueous formulations of crystalline Compound I while Table4 below lists those for aqueous formulations of crystalline Compound II.The results for aqueous formulations of crystalline Compound I are alsographically shown in FIG. 5A and FIG. 5B while the results for aqueousformulations of crystalline Compound II are graphically shown in FIG. 6Aand FIG. 6B.

TABLE 3 Crystalline Amorphous Perilymph perilymph Cochlea Average (μM)Cochlea Average (μM) Average (μM) Day (n = 6) Average (μM) (n = 3) (n =3) 1 394.7 69.0 (n = 3) 33.3 211.2 3 568.5 25.6 (n = 3) 7 18.9 4.1 (n =6) 14.0 28.4 14 116.0 9.0 (n = 6) 0.0 0.04 21 18.2 6.2 (n = 6) 28 10.412.8 (n = 6) LLOQ = 0.08 μM

TABLE 4 Crystalline Amorphous Perilymph Cochlea perilymph CochleaAverage (μM) Average (μM) Average (μM) Average (μM) Day (n = 3) (n = 3)(n = 3) (n = 3) 1 501.6 5282.0 159.4 829.2 7 26.0 46.1 178.4 18.1 1426.0 221.7 0.0 0.0 28 2.2 7.6 0.0 0.0 42 0.3 0.6 56 0.0 0.0 LLOQ = 0.08μM

Although the foregoing has been described in some detail by way ofillustrations and examples for purposes of clarity and understanding, itwill be understood by those of skill in the art that numerous andvarious modifications can be made without departing from the spirit ofthe present disclosure. Therefore, it should be clearly understood thatthe forms disclosed herein are illustrative only and are not intended tolimit the scope of the present disclosure, but rather to also cover allmodification and alternatives coming with the true scope and spirit ofthe invention.

1. Crystalline Compound I having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.2,13.8, 14.0, 18.4, and 20.9±0.15 degrees two-theta.
 2. CrystallineCompound I, according to claim 1, characterized by an x-ray powderdiffraction pattern with peaks at 4.6, 8.2, 9.2, 13.8, 14.0, 18.2, 18.4,20.9, 23.8, and 27.7±0.15 degrees two-theta.
 3. Crystalline Compound I,according to claim 1, characterized by an x-ray powder diffractionpattern with peaks at 3.0, 4.6, 8.2, 9.2, 10.4, 13.8, 14.0, 16.4, 18.2,18.4, 18.8, 19.1, 20.9, 21.5, 22.2, 22.7, 23.0, 23.8, 24.3, 24.7, 25.2,26.5, 26.6, 27.1, 27.7, 28.1, 28.3, 28.6, 29.0, 30.0, 31.2, 31.5, 31.8,32.1, 32.4, 35.1, 35.6, 35.8, 36.4, 36.7, 38.4, 38.8, 39.8, 40.5, and40.8±0.15 degrees two-theta.
 4. Crystalline Compound I, according toclaim 1, further characterized as having a differential scanningcalorimetry endotherm onset at about 238.5° C.
 5. Crystalline CompoundII having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.4,15.2, 16.0, 20.6, and 22.6±0.15 degrees two-theta.
 6. CrystallineCompound II, according to claim 5 characterized by an x-ray powderdiffraction pattern with peaks at 6.5, 8.4, 15.2, 16.0, 19.9, 20.6,22.6, 24.5, 25.1, and 30.6±0.15 degrees two-theta.
 7. CrystallineCompound II, according to claim 5, characterized by an x-ray powderdiffraction pattern with peaks at 6.5, 8.4, 10.1, 13.1, 14.6, 15.0,15.2, 16.0, 17.6, 18.0, 18.4, 19.6, 19.9, 20.1, 20.6, 20.9, 21.2, 22.2,22.6, 23.3, 23.5, 23.8, 24.5, 24.9, 25.1, 25.8, 26.1, 26.7, 26.8, 27.5,27.8, 29.6, 30.6, 31.2, 32.3, 32.9, 33.2, 33.9, 34.4, 35.4, 36.3, 36.7,37.3, 37.7, 38.0, 38.9, 40.0, 40.2, 40.8, and 41.6±0.15 degreestwo-theta.
 8. Crystalline Compound II, according to claim 5, furthercharacterized as having a differential scanning calorimetry endothermonset at about 173° C.
 9. An aqueous pharmaceutical composition forintratympanic administration comprising: (1) an active agent selectedfrom a crystalline Compound I having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.2,13.8, 14.0, 18.4, and 20.9±0.15 degrees two-theta and a crystallineCompound II having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.4,15.2, 16.0, 20.6, and 22.6±0.15 degrees two-theta and (2) apharmaceutically acceptable aqueous solution comprising: (A)approximately 15% to 25% by weight (w/w) of poloxamer 407; or (B) (i)approximately 15% to 25% by weight (w/w) of poloxamer 407 and (ii)approximately 0.5% to 4% by weight (w/w) of hydroxypropylmethylcellulose having a nominal viscosity of 40-60 cP or grade 80-120cP; or (C) (i) approximately 10%-20% by weight (w/w) of poloxamer 407,and (ii) approximately 0.1%-0.3% by weight (w/w) of Carbopol® 974P; or(D) (i) approximately 0.5% to 8% by weight (w/w) of a hyaluronic acid;or (E) (i) approximately 0.5% to 4% by weight (w/w) of a hyaluronicacid, and (ii) approximately 5% to 20% by volume of polyethylene glycol400; wherein said active agent is present in approximately 0.01% toabout 20% w/v of said aqueous solution.
 10. The aqueous pharmaceuticalcomposition according to claim 9, wherein said aqueous solutioncomprises: (A) approximately 15% to 25% by weight (w/w) of poloxamer407; or (B) (i) approximately 15% to 25% by weight (w/w) of poloxamer407 and (ii) approximately 0.5% to 4% by weight (w/w) of hydroxypropylmethylcellulose having a nominal viscosity of 40-60 cP or grade 80-120cP; or (C) (i) approximately 10%-20% by weight (w/w) of poloxamer 407,and (ii) approximately 0.1%-0.3% by weight (w/w) of Carbopol® 974P. 11.The aqueous pharmaceutical composition according to claim 9, whereinsaid aqueous solution comprises approximately 15% to 25% by weight (w/w)of poloxamer
 407. 12. The aqueous pharmaceutical composition accordingto claim 9, wherein the pH of said aqueous solution is between about 7.0and 8.0.
 13. The aqueous pharmaceutical composition according to claim9, wherein said aqueous solution further comprises a buffering agentselected from sodium phosphate monobasic, sodium phosphate dibasic, andsodium chloride, or a combination thereof.
 14. (canceled)
 15. Theaqueous pharmaceutical composition according to claim 9, wherein saidactive agent is present in approximately 0.1% to 5% w/v.
 16. (canceled)17. The aqueous pharmaceutical composition according to claim 9comprising: (1) a crystalline Compound I of claim 1, and (2) apharmaceutically acceptable aqueous solution comprising approximately15% to 25% by weight (w/w) of poloxamer 407, wherein the pH is betweenabout 7.0 and 8.0; and wherein said crystalline Compound I is present inapproximately 0.01% to 20% w/v of said aqueous solution.
 18. The aqueouspharmaceutical composition according to claim 17 wherein said aqueoussolution comprises approximately 15% to 18% by weight of poloxamer 407,and wherein said crystalline Compound I is present in approximately 0.1%to 5% w/v.
 19. (canceled)
 20. The aqueous pharmaceutical compositionaccording to claim 9 comprising: (1) crystalline Compound II of claim 5;and (2) a pharmaceutically acceptable aqueous solution comprisingapproximately 15% to 25% by weight (w/w) of poloxamer 407, wherein thepH is between about 7.0 and 8.0; and wherein said crystalline CompoundII is present in approximately 0.01% to 20% w/v of said aqueoussolution.
 21. The aqueous pharmaceutical composition according to claim20 wherein said aqueous solution comprises approximately 15% to 18% byweight of poloxamer 407, and wherein said crystalline Compound II ispresent in approximately 0.1% to 5% w/v.
 22. (canceled)
 23. A method forthe treatment of otic disorders which comprises intratympanicadministration of a therapeutically effective amount of an active agentselected from a crystalline Compound I having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.2,13.8, 14.0, 18.4, and 20.9±0.15 degrees two-theta and a crystallineCompound II having the formula:

characterized by an x-ray powder diffraction pattern with peaks at 8.4,15.2, 16.0, 20.6, and 22.6±0.15 degrees two-theta, to a patient in needthereof to an area at or near the round window membrane in the ear ofsaid patient.
 24. The method of claim 23, wherein the otic disorder ishearing loss. 25-30. (canceled)